title: Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: a multicenter registry.
abstract: BACKGROUND
  Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR.
  
  
  RESULTS
  Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively). One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity.
  
  
  CONCLUSIONS
  Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
authors.affiliation: Department of Cardiology, Istituto Clinico S. Ambrogio, Milan (F.B., M.A., S.P., R.A.L., S.L., S.C., N.B., L.T.); Interventional Cardiology Unit, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan (A.L., F.M., A.C.); Niguarda Ca Granda Hospital, Milan (F.D.M., J.O., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa (A.S.P., M.D.C.); Cardiothoracic Department, Spedali Civili, Brescia (F.E., C.F.); Azienda Ospedaliera Legnano, Legnano (A.P., S.D.S.); Ospedale di Bassano del Grappa, Vicenza (A.R.); Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova (G.T.); Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna (A.M.); Osp. San Camillo, Roma (R.F.); and Ferrarotto Hospital, Catania (G.P.U., C.T.), Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: Mauro
authors.initials: M
authors.lastname: Agnifili
authors.forename: Jacopo
authors.initials: J
authors.lastname: Oreglia
authors.forename: Samuele
authors.initials: S
authors.lastname: Pizzocri
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Latini
authors.forename: Stefania
authors.initials: S
authors.lastname: Lanotte
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Poli
authors.forename: Silvia
authors.initials: S
authors.lastname: Cirri
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Angelo
authors.initials: A
authors.lastname: Ramondo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Rosario
authors.initials: R
authors.lastname: Fiorilli
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012720:Severity of Illness Index
keywords: aortic valve; aortic valve stenosis; mitral valve insufficiency